01 November 2011

Better to have HIV than TB: SA doc

A leading South African doctor says if he had to choose between having HIV and TB, he’d choose HIV.

If he could choose between having HIV or TB, he would choose to have HIV, said Professor Francois Venter from the Wits Reproductive Health and HIV Institute in a controversial talk at the recent 42ndUnion World Conference on Lung Health held in Lille, France.

Despite high death rates in TB patients, they do not enjoy the same level of health services and treatment as HIV patients.

Venter highlighted the following areas in which TB is lagging behind HIV:

Scientific advances: Some important scientific advances and breakthroughs in HIV research, such as the microbiocide gel and preventative therapies, have taken place in recent years. But in TB, there has been little progress in the last few decades.

Diagnostic tools: HIV has highly accurate diagnostics that deliver same-day results, and can be found in even the poorest areas in the country. But until recently, it took between two and six weeks for a South African patient to get the outcome of a TB test. Earlier this year the GeneXpert TB diagnostic machine, that provides results within two hours, was released, but it is still being rolled out in the South African health system.

Quality and availability of drugs: New drugs for treating HIV are brought to market rapidly. But according to Venter: “In TB [the latest drugs] have been wandering around for 10 years, but it’s still not generally available.” Although there are robust second-line treatment for drug resistance in HIV, Venter argues that second-line HIV therapy is a lot less toxic than first-line TB therapy. For MDR and XDR-TB treatment, the drug toxicity is so high that patients have to be hospitalised to manage the side effects.

Treatment regimes: InHIV programmes, patients receive individualised counselling that informs them of the implications of their disease and treatment regimes. Patients are issued medication which they take daily on their own. TB programmes make use of the DOTS (Directly Observed Treatment Short Course) treatment regime, where patients have to take their medicine in front of an allocated person every day. According to Venter, DOTS is a patriarchal and time-consuming regime that has caused some patients to lose their jobs.

Activism: Venter commented that HIV has dedicated activists who are not scared to fight for the rights of patients, but that there is very little activism for TB patients.

Venter also added other areas in which TB lagged behind HIV which included treatment outcome, monitoring and infection control.

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